Emergency Department Process Improvement Boosts Suicide Prevention

TOPLINE: An emergency department (ED) process improvement package focusing on suicide prevention using evidence-based practices reduced suicidal behavior in patients at risk for suicide.

METHODOLOGY: 

• The National Action Alliance for Suicide Prevention and The Joint Commission consider ED as an essential setting for suicide prevention; but EDs often fail to use all suicide-related best practices.
• This ED-SAFE 2 cluster randomized trial was conducted in eight EDs across the United States.
• Each site received lean training and built a continuous quality improvement (CQI) team to review the current suicide-related workflow in the ED, identify areas for improvement, and execute initiatives to improve care.
• Across three 12-month phases (baseline, implementation, and maintenance phases), data from 2761 suicide-related ED index visits that led to discharge were evaluated.
• The primary outcome was suicide-related composite measure of ED visits due to suicidal ideation, attempt, or death within 6 months of the initial ED visit.

TAKEAWAY:

• During the 6-month follow-up period, 19.8% of patients had one suicide-related event, of which 0.3% died by suicide and 19.5% visited the ED due to suicidal ideation or attempt.
• The risk for suicide composite was 39% (adjusted odds ratio, 0.61; 95% CI, 0.46-0.79) and 43% (0.57; 0.43-0.74) lower in implementation and maintenance phases, respectively, than the baseline phase.
• The suicide composite rate reduced by approximately 6% in the 12-month period between the implementation and maintenance phases.

IN PRACTICE:

Researchers wrote, “CQI represents an implementation approach that is compatible with the culture of the US healthcare setting, allowing EDs to own suicide-related practice changes and sustain them over time.”

SOURCE: 

The ED-SAFE 2 Investigators published the study in the JAMA Psychiatryon May 17, 2023.

LIMITATIONS:

• Reliance on electronic medical records to identify eligible suicide composite outcomes led to potentially underestimated rates.
• The study had insufficient power to identify differences in deaths by suicide or attempts because of the rarity of suicide deaths.

DISCLOSURES:

The study was supported by the National Institute of Mental Health. Zeger W and Millet I received research grants from the University of Massachusetts and National Institutes of Health, respectively. Millet I also received personal fees from the National Institutes of Health.

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